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Effect of adjuvant sleep hygiene psychoeducation and lorazepam on depression and sleep quality in patients with major depressive disorders: results from a randomized three-arm intervention

Authors Rahimi A, Ahmadpanah M, Shamsaei F, Cheraghi F, Sadeghi Bahmani D, Holsboer-Trachsler E, Brand S

Received 20 April 2016

Accepted for publication 4 May 2016

Published 22 June 2016 Volume 2016:12 Pages 1507—1515

DOI https://doi.org/10.2147/NDT.S110978

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Dr Roger Pinder


Alireza Rahimi,1 Mohammad Ahmadpanah,1 Farshid Shamsaei,1 Fatemeh Cheraghi,2 Dena Sadeghi Bahmani,3 Edith Holsboer-Trachsler,3 Serge Brand3,4

1Behavioral Disorders and Substances Abuses Research Center, Hamadan University of Medial Sciences, Hamadan, 2Research Center for Chronic Disease Care at Home, Hamadan University of Medial Sciences, Hamadan, Iran; 3Psychiatric Clinics of the University of Basel, Center for Affective, Stress and Sleep Disorders (ZASS), 4Department of Sport, Exercise, and Health, Division of Sport and Psychosocial Health, University of Basel, Basel, Switzerland

Background: Sleep disturbances are a common co-occurring disturbance in patients with major depressive disorders (MDDs) and accordingly deserve particular attention. Using a randomized design, we investigated the effects of three different adjuvant interventions on sleep and depression among patients with MDD: a sleep hygiene program (SHP), lorazepam (LOR), and their combination (SHP–LOR).
Methods: A total of 120 outpatients with diagnosed MDD (mean age: 48.25 years; 56.7% females) and treated with a standard SSRI (citalopram at 20–40 mg at therapeutic level) were randomly assigned to one of the following three conditions: SHP (n=40), LOR (1 mg/d; n=40), SHP–LOR (1 mg/d; n=40). At the beginning and at the end of the study 8 weeks later, patients completed two questionnaires, the Pittsburgh Sleep Quality Index to assess sleep and the Beck Depression Inventory to assess symptoms of depression.
Results: Sleep disturbances decreased over time and in all groups. No group differences or interactions were observed. Symptoms of depression decreased over time and in all three groups. Reduction in symptoms of depression was greatest in the SHP–LOR group and lowest in the LOR group.
Conclusion: The pattern of results suggests that all three adjuvant treatments improved symptoms of sleep disturbances and depression, with greater benefits for the SHP–LOR for symptoms of depression, but not for sleep. Nevertheless, risks and benefits of benzodiazepine prescriptions should be taken into account.

Keywords: sleep hygiene, psychoeducation, pharmacotherapy, lorazepam, sleep disturbances, depression

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